Multi-Faceted Approach to Ventricular Tachycardia: A Review of Management Strategies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors,

Thank you for having the opportunity to assess your extensive manuscript on ventricular tachykardia. It is quite a quite comprehensive overview of current knowledge and I find it interesting for a broader audience, especially perhaps for students or young doctors.

However, there are some points that need to be addressed in order to move further:

-) The plagiarism software detected over 20% very similar material to other publications. It seems that nearly all your Methods section matches previous records. I would strongly advise to run your manuscript through a software of your own and remove similarities. I'm sure this has happened by mistake but must be corrected nevertheless.

-) You provide very little information about your Methods. I understand you "only" wrote a narrative review, but even for these reviews, there are guidelines you should adhere to, especially when it comes to reporting your methodology. For instance hat was your search strategy and who developed it? Please also add your search strategy as a supplement.

-) You give a huge amount of information which is fine for a review, but I did not really feel "carried through" when reading it. Please let the manuscript be read by a "third party" again, maybe even students, and ask them where to best streamline and establish a common thread throughout the text. I would want to be taken onto a journey with a clear picture in mind what I have learned after reading this.

Comments on the Quality of English Language

Only minor errors to be corrected, for instance missing articles.

Author Response

Comment #1: The plagiarism software detected over 20% very similar material to other publications. It seems that nearly all your Methods section matches previous records. I would strongly advise to run your manuscript through a software of your own and remove similarities. I'm sure this has happened by mistake but must be corrected nevertheless.

Response: Thank you for the comment. We ran the manuscript thru the Scribbr plagiarism checker and received 12% similarity findings. The majority was flagged from the MDPI template as well as the methods section. The reaminder of the highlighted areas come from the bibliography or flagged commen phrases. There are appropriate citations throughout all highlighted text. We ended up removing the methods section, please see the response below.

Comment #2: You provide very little information about your Methods. I understand you "only" wrote a narrative review, but even for these reviews, there are guidelines you should adhere to, especially when it comes to reporting your methodology. For instance, what was your search strategy and who developed it? Please also add your search strategy as a supplement.

Response: We received some conflicting feedback from reviewers on our methods section. Ultimately, this paper is a narrative review so there were not inclusion or exclusion criteria strictly adhered to. Since it was a narrative review we decided to omit a methods section to avoid confusion.

 

Comment #3: You give a huge amount of information which is fine for a review, but I did not really feel "carried through" when reading it. Please let the manuscript be read by a "third party" again, maybe even students, and ask them where to best streamline and establish a common thread throughout the text. I would want to be taken onto a journey with a clear picture in mind what I have learned after reading this.

Response: Thank you for the comment. We edited significant portions of the paper including the introduction, and gene therapy portion to remove some technical information that did make it difficult to follow the text. We also edited other sections to make them more readable. We believe these improvements do enhance the overall readability of the paper.

Reviewer 2 Report

Comments and Suggestions for Authors

I found the study titled "Multi-Faceted Approach to Ventricular Tachycardia: A Review of Management Strategies" to be really engaging. The review is skillfully composed, with the writers aiming to provide a thorough examination of the history and epidemiology of VT, significant clinical studies, and the current function of the most crucial therapeutic approaches. Nevertheless, I would propose the subsequent suggestions:

1.     Paragraphs and text editing should be improved to enhance readability. 

2.     I suggest including a primary figure in the review that highlights the significant management tactics in VT. 

3.     It is necessary to include a section on Limitations and Future directions.

 

Author Response

Comment #1: Paragraphs and text editing should be improved to enhance readability. 

Response #1: Thank you for the comment. We edited significant portions of the paper including the introduction, and gene therapy portion to remove some technical information that did make it difficult to follow the text. We also edited other sections to make them more readable. We believe these improvement do enhance the overall readability of the paper.

Comment #2: I suggest including a primary figure in the review that highlights the significant management tactics in VT. 

Response#2: We added a primary figure summarizing the multifaceted approached to treatment of VT

Comment #3: It is necessary to include a section on Limitations and Future directions.

Response #3: Thank you for the comment. After looking at the flow of the paper we decided to put the gene therapy information into a future directions section. We also added a section on artificial intelligence and its role in the treatment of VT, as well as computational analysis.

Reviewer 3 Report

Comments and Suggestions for Authors

In this narrative review, the authors aimed to discuss VT and the current management landscape. Overall, this is a nicely written manuscript. However, some issues are present and need to be addressed:

1) Methods section is not required for a narrative review. If the authors performed the search systematically, they have to label this manuscript as a systematic review and follow PRISMA guideline. Please clearly define the type of this manuscript.

2) The authors did not mention the existence and importance of computational modeling in cardiac arrhythmia, including VT management, and discuss how it could help in identifying the risk of arrhythmic events (PMID: 38153307; 35406654)

3) Regarding AADs, the authors need to add digoxin as well. It would be important to see how it affects VT. 

4) When explaining about those AADs, it is necessary to add the class of recommendations (and the recommendations, of course) provided by large cardiology societies, such as AHA and ESC. Please add them to the corresponding subsections. 

5) Please briefly discuss the Sicillian-Gambit classification as well. 

6) Also, there has been a major change to the classical Vaughan-William classes recently. Please discuss it as well (PMID: 30354657)

7) Computational Modeling has been used to study these AADs in silico. I think this worth mentioning (PMID: 31493513). 

Author Response

Comment #1: Methods section is not required for a narrative review. If the authors performed the search systematically, they have to label this manuscript as a systematic review and follow PRISMA guideline. Please clearly define the type of this manuscript.

Response: Thank you for the feedback. This is a narrative review and based on this feedback we decided to remove the methods section. We added more specific language in the introduction to clarify this status and hopefully make it less ambiguous.

 

Comment #2: The authors did not mention the existence and importance of computational modeling in cardiac arrhythmia, including VT management, and discuss how it could help in identifying the risk of arrhythmic events (PMID: 38153307; 35406654)

Response #2: Thank you for the comment. We added a section about artificial intelligence to a future direction section of the review. In this section we discussed the role of computational analysis and its interaction with AI algorithms.

 

Comment #3: Regarding AADs, the authors need to add digoxin as well. It would be important to see how it affects VT. 

Response #3: We added a short section about digoxin during in the anti-arrhythmic medication section, however we feel that the role of digoxin is primarily in heart failure and atrial fibrillation. We do think the role that digoxin can play in the precipitation of ventricular tachycardia warrants mention in this review. Although there are some case reports of digoxin use in ventricular tachycardia, we do not feel it has a significant conventional role in the management of ventricular tachycardia.

 

Comment #4: When explaining about those AADs, it is necessary to add the class of recommendations (and the recommendations, of course) provided by large cardiology societies, such as AHA and ESC. Please add them to the corresponding subsections. 

Response#4: We added society guideline recommendations when discussion AAD in the setting of particular disease entities under the “Special Populations” section.

 

Comment #5: Please briefly discuss the Sicillian-Gambit classification as well. 

Response#5: Thank you for this feedback. We agree that the Sicilian Gambit model warrants mention especially since we are submitting to a pharmacology journal. It is an important paper to be aware of when it comes to understanding of arrhythmias and therapueutic targets, however since it is not in wide clinical practice we did not feel that a detailed review of this will add much as it is not a ‘classification system’ in the traditional sense.

 

Comment #6: Also, there has been a major change to the classical Vaughan-William classes recently. Please discuss it as well (PMID: 30354657)

Response#6: This is a great point. We updated the anti-arrhythmic section to mention this update and briefly discuss other classes aside from class I-IV. We re-ordered the discussion of ranolazine since the new classification system recommends categorizing it as a class 1D agent. It is now discussed along with the other class 1 agents. We do think this improves the organization of the section.

Comment #7: Computational Modeling has been used to study these AADs in silico. I think this worth mentioning (PMID: 31493513). 

Response#7: We considered this feedback but ultimately had difficulty incorporating this concept into our review. It is certainly a worthwhile topic, but we did not feel like we could give it justice within the context of our review.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for having addressed my comments. I still think the paper needs a "Methods" section and I do not see how such a section would be "confusing" to readers? One has to know how you collected your information.

Author Response

Comments #1: Thank you for having addressed my comments. I still think the paper needs a "Methods" section and I do not see how such a section would be "confusing" to readers? One has to know how you collected your information.

Response #1: We added back a brief methods section to convey our search strategy, but used more clarifying language to emphasize that this is a narrative review. 

Reviewer 3 Report

Comments and Suggestions for Authors

Thanks for the response, but I think the authors need to explain what the novelty of this paper is. What is the added value compared to previous reviews on the same topic? 

Author Response

Comment #1: Thanks for the response, but I think the authors need to explain what the novelty of this paper is. What is the added value compared to previous reviews on the same topic?

 

Response #1: This review does include some knowledge on prior trials and some pharmacology that has been discussed previously but we do think it is relevant in the approach to VT. Our review had emphasis on special populations which are prone to VT and discussed the pharmacologic approach to these substrates. Additionally, our review on research into gene therapy as a possible burgeoning treatment in certain genetic conditions the predispose to VT makes our paper unique. After the first rounds of edits we did think that there was too much technical information about the research in gene therapy so we condensed it to a more succinct section. However, the references are still relevant and we think this makes the paper a valuable resource.

Round 3

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for addressing the comments.

Comments on the Quality of English Language

None.

Reviewer 3 Report

Comments and Suggestions for Authors

Thanks for the response